Provider Demographics
NPI:1558335083
Name:MANOS, PETER NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NICHOLAS
Last Name:MANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-4321
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:989 RIBAUT RD
Practice Address - Street 2:STE 340
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5426
Practice Address - Country:US
Practice Address - Phone:843-521-8484
Practice Address - Fax:843-521-8485
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15929207RS0012X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMPA968Medicaid
A99576Medicare UPIN
SC4221Medicare ID - Type Unspecified
SCMPA968Medicaid